| NPI | 1477516078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 296155) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD018341E) |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2018-10-18 |